Original Article

CME Article: Implementation of a Postpartum Note Reminder and Factors Associated with Postpartum Glucose Tolerance Screening

Authors: Anna Domingo, DO, Joshua Fogel, PhD, Ryan Raffel, MD, Timothy Gesner, DO, Petr Itzhak, DO


Objectives: Although reminder systems are used to increase provider adherence, we are not aware of any real-time reminder systems for provider adherence to postpartum glucose tolerance testing. We studied whether a reminder in the electronic medical records affects provider ordering of a postpartum glucose tolerance test. We also studied whether any demographic, medical history, prenatal, or delivery variables are associated with patient attendance to a postpartum visit and patient completion of the postpartum glucose tolerance test when ordered.

Methods: This was a retrospective study of 246 women diagnosed as having gestational diabetes mellitus who completed prenatal care and delivered at a suburban public safety-net hospital.

Results: Implementation of the real-time postpartum note reminder system significantly improved provider adherence to postpartum glucose screening recommendations from 58.1% to 75.0% (P = 0.01). Delivery complications were significantly associated with increased odds for postpartum visit attendance (odds ratio [OR] 3.80, 95% confidence interval [CI] 1.63–8.86, P < 0.01). Increased gestational age at first prenatal visit was significantly associated with decreased odds for postpartum visit attendance (OR 0.93, 95% CI 0.87–0.99, P < 0.05). Speaking Spanish was associated with an increased odds for completion of the postpartum glucose tolerance test when ordered (OR 2.88, 95% CI 1.24–6.70, P = 0.01).

Conclusions: We recommend that hospital managers include a reminder system in the electronic medical record. Providers should focus counseling on the potential future risks to the mother, in addition to encouraging continued adherence to postpartum care. Providers also should counsel those who present later to prenatal care about the importance of obtaining postpartum glucose tolerance tests.
Posted in: Obstetrics and Gynecology63 Pregnancy27

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Deputy NP, Kim SY, Conrey EJ, et al. Prevalence and changes in preexisting diabetes and gestational diabetes among women who had a live birth— United States, 2012–2016. MMWR Morb Mortal Wkly Rep 2018;67:1201–1207.
2. Dennison RA, Chen ES, Green ME, et al. The absolute and relative risk of type 2 diabetes after gestational diabetes: a systematic review and metaanalysis of 129 studies. Diabetes Res Clin Pract 2021;171:108625.
3. Li Z, Cheng Y, Wang D, et al. Incidence rate of type 2 diabetes mellitus after gestational diabetes mellitus: a systematic review and meta-analysis of 170, 139 women. J Diabetes Res 2020;2020:3076463.
4. American College of Obstetricians and Gynecologists. ACOG Committee Opinion no. 736: optimizing postpartum care. Obstet Gynecol 2018;131:e140–e150.
5. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin no. 190: gestational diabetes mellitus. Obstet Gynecol 2018;131:e49–e64.
6. American Diabetes Association. Position statement 14. Management of diabetes in pregnancy: standards of medical care in diabetes—2020. Diabetes Care 2020;43(Suppl 1):S183–S192.
7. Herrick CJ, Keller MR, Trolard AM, et al. Factors associated with postpartum diabetes screening in women with gestational diabetes and Medicaid during pregnancy. Am J Prev Med 2021;60:222–231.
8. Herrick CJ, Puri R, Rahaman R, et al. Maternal race/ethnicity and postpartum diabetes screening: a systematic review and meta-analysis. J Womens Health 2020;29:609–621.
9. Ko JY, Dietz PM, Conrey EJ, et al. Strategies associated with higher postpartum glucose tolerance screening rates for gestational diabetes mellitus patients. J Womens Health 2013;22:681–686.
10. Almario CV, Ecker T, Moroz LA, et al. Obstetricians seldom provide postpartum diabetes screening for women with gestational diabetes. Am J Obstet Gynecol 2008;198:528.e1–528.e5.
11. Rotem R, Salem-Yaniv S, Sandler-Rahat H, et al. Adherence to postpartum diabetes mellitus screening. Do associated pregnancy complications make a difference? Diabetes Res Clin Pract 2020;159:107972.
12. Rosenbloom JI, Blanchard MH. Compliance with postpartum diabetes screening recommendations for patients with gestational diabetes. J Womens Health 2018;27:498–502.
13. Hamel MS, Werner EF. Interventions to improve rate of diabetes testing postpartum in women with gestational diabetes mellitus. Curr Diab Rep 2017;17:7.
14. Martinez NG, Niznik CM, Yee LM. Optimizing postpartum care for the patient with gestational diabetes mellitus. Am J Obstet Gynecol 2017;217:314–321.
15. Wilcox A, Levi EE, Garrett JM. Predictors of non-attendance to the postpartum follow-up visit. Matern Child Health J 2016;20:22–27.
16. Battarbee AN, Yee LM. Barriers to postpartum follow-up and glucose tolerance testing in women with gestational diabetes mellitus. J Perinatol 2018;35:354.
17. de Gennaro G, Bianchi C, Aragona M, et al. Postpartum screening for type 2 diabetes mellitus in women with gestational diabetes: is it really performed? Diabetes Res Clin Pract 2020;166:108309.
18. Cabizuca CA, Rocha PS, Marques JV, et al. Postpartum follow up of gestational diabetes in a tertiary care center. Diabetol Metab Syndr 2018; 10:1–6.
19. Grotell LA, Bryson L, Florence AM, et al. Postpartum note template implementation demonstrates adherence to recommended counseling guidelines. J Med Syst 2021;45:1–6.
20. Costas-Muniz R, Jandorf L, Philip E, et al. Examining the impact of Latino nativity, migration, and acculturation factors on colonoscopy screening. J Community Health 2016;41:903–909.
21. Bernstein JA, McCloskey L, Gebel CM, et al. Lost opportunities to prevent early onset type 2 diabetes mellitus after a pregnancy complicated by gestational diabetes. BMJ Open Diabetes Res Care 2016;4:e000250.
22. Lithgow GE, Rossi J, Griffin SJ, et al. Barriers to postpartum diabetes screening: a qualitative synthesis of clinicians’ views. Br J Gen Pract 2021;71:e473–e82.